Impact of de novo vesicoureteral reflux on transurethral surgery outcomes in pediatric patients with ureteroceles

• Published in: Investigative and clinical urology 2019, 60(4), , pp.295-302
• Main Authors: Song, Sang Hoon, Lee, Dong Hyun, Kim, Hwiwoo, Lee, Jongpil, Lee, Sangmin, Ahn, Donghyun, Park, Sungchan, Kim, Kun Suk
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; Endoscopy; Female; Humans; Infant; Kidney Diseases - etiology; Kidney Diseases - physiopathology; Male; Original; Postoperative Complications - etiology; Punctures; Punctures - methods; Retrospective Studies; Treatment Outcome; Ureterocele; Ureterocele - complications; Ureterocele - surgery; Ureteroscopy; Urethra; Urinary tract infections; Urinary Tract Infections - etiology; Urologic Surgical Procedures - methods; Vesico-ureteral reflux; Vesico-Ureteral Reflux - complications; 비뇨기과학
• ISSN: 2466-0493; 2466-054X
• DOI: 10.4111/icu.2019.60.4.295

We aimed to determine the impact of vesicoureteral reflux (VUR) on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles. We retrospectively reviewed the medical records of 34 patients (36 renal units) with ureteroceles that were treated endoscopically. Perioperative radiologic and clinical data regarding VUR, UTI, and renal function were analyzed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, and deterioration of renal function. Of the 36 renal units, 22 had a duplex system (61.1%). Preoperative VUR was noted in 9 units (25.0%), including 3 units without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 28 units (77.8%). VUR developed in 18 renal units (50.0%) postoperatively. The absence or presence of VUR was not related to unfavorable surgical outcomes in univariate or multivariate analyses. Even after selection for the 28 renal units without preoperative VUR, the occurrence of VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 14 renal units without renal duplication, VUR had no predictive value for any of these adverse outcomes. After endoscopic ureterocele puncture, VUR is not significantly associated with postoperative UTI or deterioration in renal function in the long term. It may not, therefore, be necessary to reconstruct lower urinary tract routinely to correct VUR after endoscopic puncture of the ureterocele.